Safety Information

In this section:

Safety involves a state of being free from risk or occurrence of injury, harm, or danger. Individuals who
practice
aromatherapy need to be aware of the safety issues involved with using essential oils in order to avoid
potential
adverse effects. According to Burfield, “Although many essential oils are potentially hazardous
materials,
if handled in the appropriate manner, the risks involved in their use can be very small. So therefore, most
commercially offered essential oils are safe to use for the purpose intended in a domestic/ professional or
clinical
environment.”1 The informed use of essential oils may create occasional irritation or
minor
discomfort, but it is extremely unlikely to create serious injury or lasting physical problems,2
particularly when basic guidelines are followed.

Factors that influence the safety of essential oils include

Quality of essential oil being utilized

Adulterated essential oils increase the likelihood
of
an adverse response and hence the need for pure, authentic, and genuine essential oils is of the utmost
importance.

Chemical composition of the oil

Essential oils rich in aldehydes (e.g., citronellal,
citral)
and phenols (e.g., cinnamic aldehyde, eugenol) may cause skin reactions. Essential oils rich in these
constituents
should always be diluted prior to application to the skin. According to Schnaubelt, “diluting such
oils so
that the resulting solution becomes non-irritant, may require diluting them to concentrations much lower
than in
normal circumstances. Another option is to blend such irritant oils asymmetrically with other essential
oils,
which
mitigate their irritant effects.”3

Method of application

Essential oils may be applied on the skin (dermal application),
inhaled,
diffused or taken internally. Each of these methods have safety issues which need to be considered. The
potential
safety concerns with dermal application will be discussed below. With regard to inhalation, from a
safety
standpoint, inhalation presents a very low level of risk to most people. Even in a relatively small
closed
room,
and
assuming 100% evaporation, the concentration of any essential oil (or component thereof) is unlikely to
reach a
dangerous level, either from aromatherapy massage, or from essential oil vaporization.4

Tisserand and Balacs further point out that “the only likely risk would be from prolonged exposure
(perhaps 1
hour or more) to relatively high levels of essential oil vapor which could lead to headaches, vertigo,
nausea
and
lethargy”. With regard to internal use, NAHA does not support the indiscriminate internal use of
essential
oils. Click here
for
more
information.

Dosage/dilution to be applied

Most aromatherapy oil based blends will be between 1
and
5
percent dilutions, which typically does not represent a safety concern. As one increases dilution,
potential
dermal
(skin) reactions may take place depending on the individual essential oil, the area in which the oil is
applied,
and
other factors related to the client’s own sensitivity levels. Any excessive usage of essential
oils
may
cause
irritation or other undesired effects due to their lipophilic nature.5

Integrity of skin

Damaged, diseased, or inflamed skin is often more permeable to
essential
oils
and may be more sensitive to dermal reactions. It is potentially dangerous to put undiluted essential
oils
on to
damaged, diseased or inflamed skin. Under these circumstances the skin condition may be worsened, and
larger
amounts
of oil than normal will be absorbed. Sensitization reactions are also more likely to occur.6

Age of client

Infants, toddlers, and young children are more sensitive to the
potency
of
essential oils and safe dilutions generally range from 0.5 - 2.5% depending on the condition. Certain
essential
oils
should either be avoided, used in highly diluted form under the guidance of a knowledgeable
professional, or
included as a minor percentage in a professionally-formulated essential oil blend. For example, special
caution
should be exercised with potentially toxic essential oils such as Birch and Wintergreen which are both
high
in
methyl salicylate, Eucalyptus which is high in 1,8 cineole and Peppermint which is high in menthol.
Elderly
clients
may have more skin sensitivities so a reduced concentration/dilution may be indicated.

Possible Dermal Reactions

Of primary importance to the aromatherapists is the safety of essential oil application to the skin. Dermal
or
skin
reactions that may occur with essential oils include: irritation, sensitization and
phototoxicity/photosensitization.

Dermal irritant

A dermal irritant will produce an immediate effect of irritation on the skin. The reaction will be
represented
on
the skin as blotchy or redness, which may be painful to some individuals. The severity of the reaction
will
depend
on the concentration (dilution) applied.

General safety guidelines include: avoid application of known dermal irritant essential oils on any
inflammatory
or
allergic skin condition; avoid undiluted application; avoid application on open or damaged skin; and
dilute
known
dermal irritants with appropriate vegetable oil or other carrier. If you suspect a client has sensitive
skin,
perform a skin patch test. Table 1 lists some common essential oils considered to be dermal
irritants.

Dermal Irritants (Table 1)

Essential Oil

Latin Name

Bay

Pimento racemosa

Cinnamon bark or leaf

Cinnamomum zeylanicum*

Clove bud

Syzygium aromaticum

Citronella

Cymbopogon nardus

Cumin

Cuminum cyminum

Lemongrass

Cymbopogon citratus

Lemon verbena

Lippia citriodora

Oregano

Origanum vulgare

Tagetes

Tagetes minuta

Thyme ct. thymol

Thymus vulgaris

*bark is more irritating than leaf

Dermal sensitization

Dermal sensitization is a type of allergic reaction. It occurs on first exposure to a substance, but on
this
occasion, the noticeable effect on the skin will be slight or absent. However, subsequent exposure to
the
same
material, or to a similar one with which there is cross-sensitization, produces a severe inflammatory
reaction
brought about by cells of the immune system (T-lymphocytes).7 The reaction will be
represented on
the
skin as blotchy or redness, which may be painful to some individuals.

The problem with dermal sensitization is that once it occurs with a specific essential oil the
individual is
most
likely going to be sensitive to it for many years and perhaps for the remainder of his/her life. The
best
way to
prevent sensitization is to avoid known dermal sensitizers and avoid applying the same essential oils
every
day
for
lengthy periods of time. Sensitization is, to an extent, unpredictable, as some individuals will be
sensitive to
a
potential allergen and some will not.8

According to Burfield (2004), the following oils listed in Table 2 are considered to be dermal
sensitizers
and
are
not recommended for use in aromatherapy massage.

Dermal Sensitizers (Table 2)

Essential Oil

Latin Name

Cassia

Cinnamomum cassia

Cinnamon bark

Cinnamomum zeylanicum

Peru balsam

Myroxylon pereirae

Verbena absolute

Lippia citriodora

Tea absolute

Camellia sinensis

Turpentine oil

Pinus spp.

Backhousia

Backhousia citriodora

Inula

Inula graveolens

Oxidized oils from Pinaceae family (e.g., Pinus and Cupressus species) and Rutaceae family
(e.g.,
citrus
oils)

Photosensitization

An essential oil that exhibits this quality will cause burning or skin pigmentation changes, such as
tanning, on
exposure to sun or similar light (ultraviolet rays). Reactions can range from a mild color change
through to
deep
weeping burns. Do not use or recommend the use of photosensitizing essential oils prior to going
into a
sun
tanning booth or the sun. Recommend that the client stay out of the sun or sun tanning booth for at
least
twenty-four hours after treatment if photosensitizing essential oils were applied to the skin.
Certain
drugs,
such as tetracycline, increase the photosensitivity of the skin, thus increasing the harmful effects of
photosensitizing essential oils under the necessary conditions. Table 3 lists some common essential oils
considered
to be photosensitizers.

Photosensitizers (Table 3)

Essential Oil

Latin Name

Angelica root

Angelica archangelica

Bergamot

Citrus bergamia

Cumin

Cuminum cyminum

Distilled or expressed grapefruit (low risk)

Citrus paradisi

Expressed lemon

Citrus limon

Expressed lime

Citrus medica

Orange, bitter (expressed)

Citrus aurantium

Rue

Ruta graveolens

Non-Phototoxic Citrus Oils (Table 4)

Essential Oil

Latin Name

Bergamot: Bergapteneless
(FCF: Furanocoumarin Free)

Citrus bergamia

Distilled lemon

Citrus limon

Distilled lime

Citrus medica

Mandarin - Tangerine

Citrus reticulata

Sweet orange

Citrus sinensis

Expressed tangerine

Citrus reticulata

Yuzu oil (expressed or distilled)

Citrus juno

Idiosyncratic irritation or sensitization

Idiosyncratic irritation or sensitization is an uncharacteristic or unusual reaction to a commonly used
essential
oil. This type of reaction is difficult to predict and rarely occurs but is a possibility.

Mucous membrane irritant

A mucous membrane irritant will produce a heating or drying effect on the mucous membranes of the mouth,
eyes,
nose,
and reproductive organs. It is recommended that mucus membrane irritating essential oils not be used in
the
bath
unless they are adequately diluted in a dispersant such as natural bath gel base, polysorbate or
vegetable
oil.
Bay,
clove, cinnamon bark, lemongrass, and thyme ct. thymol essential oils should be avoided in baths
completely.
Table 5
lists some common essential oils considered to be mucous membrane irritants.

The use of essential oils during pregnancy is a controversial topic and one that is yet to be fully
understood. The main concern during pregnancy appears to be the risk of essential oil constituents
crossing over into the placenta. According to Tisserand and Balacs, crossing the placenta does not
necessarily mean that there is a risk of toxicity to the fetus; this will depend on the toxicity and the
plasma concentration of the compound.9 It is probable that essential oil metabolites cross the placenta
due to the intimate (but not direct) contact between maternal and embryonic or fetal blood.10

Jane Buckle comments “the use of essential oils in pregnancy is a contentious subject, especially
during
the
vital first 3-month period. It is extremely unlikely that a nightly bath containing a few drops of
essential
oils
will cause any problems for the unborn child” and later states “there are no records of
abnormal
fetuses
or aborted fetuses due to the ‘normal’ use of essential oils, either by inhalation or
topical
application.”11

According to Wildwood, “A common myth in aromatherapy is that massage oils containing essential
oils
such
as
Clary sage, rose or even rosemary can cause a miscarriage and hence should be avoided throughout
pregnancy."
Authors such as Ron Guba, Kurt Schnaubelt, and Chrissie Wildwood have all pointed out that there have
been
‘no
recorded cases of miscarriage or birth defect resulting from aromatherapy massage using therapeutic
applications
of
any essential oil.”12

Ron Guba points out that toxicity during pregnancy is almost exclusively due to pregnant women taking
large,
toxic
doses of essential oils, notably pennyroyal (rich in the ketone, pulegone, which is metabolized to the
highly
toxic
furan epoxide, menthofuron) and parsley seed (rich in the dimethyl ether, apiol) in an attempt to abort
the
fetus.13 And Battaglia shares this insight: “the judicious use of essential oils
together
with
appropriate forms of massage by a skilled therapist can help ease the discomforts of pregnancy and
provide a
sense
of nurturing that will comfort the mother at times she is likely to be feeling rather
fragile.”14

Due to the lack of clear information regarding the toxicity of essential oils during pregnancy, it would
be
best
to
adhere to general safety guidelines. According to Tisserand and Balacs, the following essential oils
should
not
be
used during pregnancy: wormwood, rue, oak moss, Lavandula stoechas, camphor, parsley seed,
sage,
and
hyssop.15

Essential Oils and Eye Safety

There has been much social media discussion recently (February 2012) about the wisdom or otherwise of
putting
essential oils into your eyes to treat eye problems. This arose from two webpages, here and
(2nd page no longer available). One of these, on the Livestrong website, states:

“More and more people
are
choosing to use alternative medicines to treat minor illnesses rather than taking a
prescription.
Putting
essential
oils in or near the eyes isn’t something that is widely known about, but there are several
that
can
aid in
the
treatment of eye problems. Before using essential oils for your eyes, always contact your
doctor.

Clary sage is the essential oil that is most widely used to treat vision problems. It is
placed
in
the
eye,
so
advice from an optometrist is important before use. Clary sage is used as a cleanser for the
eyes.
It
can
also
be used to clear eye sight due to foggy vision or an injury to the eyes. Clary sage can also
be
used
to
brighten
the eyes and improve vision. Finally, it can have beneficial results for people with eye
issues
related
to
aging.”
Eliza Martinez

EYE IMAGE: Damage to the cornea after inadvertent adminstration of Olbas Oil.
Courtesy of Nature Publishing Group

This actually dates from May 2010, but judging from the related comments, has only recently been
noticed.
The
statement that “Clary sage is the essential oil that is most widely used to treat vision
problems”
is
not true, since there are no essential oils commonly used to treat vision problems. The only evidence
for
any
essential oil treating any eye problem relates to tea tree oil and eyelash mites (see below). The
reference
to
clary
sage probably derives from 17th century European herbalists, but this refers to using clary sage seeds,
or
mucilage
made from them, and not to clary sage essential oil: “The seed put into the eyes clears them from
motes
and
such like things gotten within the lids to offend them, and it also clears them from any white and red
spots
which
may be on them” (Culpeper 1652). Another common name for clary sage (Salvia sclarea) was
“clear
eye” because of this common use of the seeds, which probably pre-dated Culpeper by many years.
“Clary”
may derive from “clear-eye.”

Not only is there no evidence that any essential oil can help with vision problems, age-related or
otherwise,
but
placing any essential oil “in the eye” is extremely dangerous advice. Almost any undiluted
essential
oil
coming into contact with the ocular membranes will be corrosive, possibly causing scarring of the
cornea,
and
certainly causing significant pain.

Eye damage I could find no reports in the literature of ocular accidents involving single essential
oils,
but
there
are several for Olbas oil. This is a mixture of essential oils and menthol:

A 2009 report from an ophthalmologist in Bristol UK, describes partial loss of corneal tissue (ie
erosion)
when
a
73-year-old man dripped Olbas Oil into his left eye (he had no right eye) because he thought he was
using
eye
drops
(see picture above). He was “considerably incapacitated”, but recovered after a week of
treatment
with
“topical antibiotics and lubricants”. On checking, the author found that just his hospital,
in
the
previous 18 months, had seen 12 patients who had mistakenly dripped Olbas Oil into one eye. He describes
the
result
as a chemical burn, though he found that Olbas Oil in tears was pH neutral (most chemical burns are
caused
by
substances that are strongly acid or alkaline). All “Olbas Oil patients” recovered fully
within
one
week
following intensive treatment (Adams et al 2009).

Olbas Oil may cause problems even when not applied directly to the eyes. The mother of a 4-month-old boy
placed
several drops of Olbas Oil in his right nostril in an attempt to help his respiratory infection, not
realizing
that
the product warns against use in infants. The child immediately showed signs of respiratory distress,
and
was
taken
to the emergency room. Two hours after admission his eyes became inflamed, and examination revealed
bilateral
superficial corneal scarring. He also had conjunctivitis, and could not open his eyes. They were flushed
with
saline
over four days, and he recovered with no residual scarring (Wyllie and Alexander 1994).

Emergency treatment

More than 65,000 work-related eye injuries and illnesses are reported annually in the USA, a “significant
percentage” of these being ocular chemical burns. They require rapid treatment, and severe burns
have
a
poor
prognosis. The standard treatment is copious irrigation with saline solution for 1-2 hours. Contact
lenses
should
not be removed initially (Peate 2007). With essential oils, fatty oil has been suggested as an
appropriate
first
aid
treatment though the advantage of saline is that the eyes can be continually flushed, and this is less
easy
with
fatty oil.

What about diluted essential oils?

The second article describes using essential oils diluted to (by my estimation) about 3%. It includes
the
following
advice:
“Here is a truly natural solution, which has been shown to benefit your eye health and the only
one I
will
use. Gary Young has used this recipe for his patients at the Ecuador Clinic for macular degeneration,
health
issues,
cataracts, and improving sight. I’ve been using it for a couple of years and love it! I started
using
this
recipe before I had to have a vision exam in order to purchase new contacts. And I knew my vision had
deteriorated
from my last exam. So I put the drops in my eyes every night for about 6 months prior to the exam and my
prescription had not changed according to their records, but I know what I was not seeing and I know
what I
was
seeing as a result of using these drops – clearly my vision had improved! The recipe is as
follows:

Put oils in a glass dropper bottle with a lid on it. My experience has been that I can see much more
clearly
just
after putting the drops in my eye so I am also going to experiment with putting a drop in my eyes in the
morning”
(Diana
Ewald).

“V-6” is a proprietary blend of vegetable oils. The above implies that using these oils on a
daily
basis
is likely to have a healing effect in cases of cataract, macular degeneration or failing eyesight.
Although
the
article continues to describe various effects of the essential oils, none of them have any relationship
with
any
of
these conditions. So the question arises – how to weigh potential benefits against potential
risks?

The word “experiment” in the above seems appropriate. Eyesight problems are difficult to
treat,
and
once
damage has occurred, recovery is not always simple. A 3% dilution may not be sufficient to cause corneal
erosion,
but on the other hand there is no evidence of any benefit. One concern is that the wrong dilution may be
used,
and
the risk of this is substantial. For example, it would be easy to confuse “tbsp” with tsp”,
resulting in a dilution of about 10% instead of 3%.

In a Chinese study, an ointment containing 5% tea tree oil was used by patients whose eyelash follicles
were
infested with “eyelash mites” (Demodex folliculorum). The ointment was applied to
the
lid
margins with eyes closed, daily for 4 weeks after washing the face, and resulted in considerably less
itching
and
fewer mites. Two of the 24 patients experienced slight irritation from the ointment. The 5%
concentration
was
arrived at after preliminary testing using various dilutions on rabbit eyes (Gao et al 2012).

Conclusions

* Undiluted essential oils should not be applied to the eyes.
* It is rash to suggest that essential oils are commonly used to treat eye problems
* Eye injuries and diseases are medical conditions, and any product claiming to treat them is a
medicine,
subject to
drug legislation.
* There is currently no evidence that applying dilutions of essential oil to the eyes will be beneficial
in
any
condition.
* Diluted (5%) tea tree oil may help eradicate eyelash mites, but it should not be placed into the eyes.

References

Culpeper N 1652 The English Physitian, or an Astro-physical discourse of the vulgar herbs of this
nation. Being
a
compleat method of physick, whereby a man may preserve his body in health; or cure himself, being sick.
Thomas
Kelly, London

This article also appears in the International Journal of Professional Holistic Aromatherapy, Vol. 1
Issue
4

General Safety

General Safety Precautions

Keep all essential oils out of reach of children and
pets.

Do not use or recommend the use of photosensitizing
essential oils prior to going into a sun tanning booth or
the
sun. Recommend that the client stay out of the sun or sun tanning booth for at least twenty-four hours
after
treatment if photosensitizing essential oils were applied to the skin.

Avoid prolonged use of the same essential oils unless they
are being used under the guidance of a qualified
health professional.

Avoid the use of essential oils you know nothing about on
your clients. Research and get to know the oil
prior to
using it on others.

Avoid the use of undiluted essential oils on the skin,
unless otherwise indicated.

If you suspect your client may be sensitive to specific
essential oils or if your client has known allergies
or sensitivities, it may be wise to perform a skin patch test.

Know the safety data on each essential oil and place into
context of use and knowledge.

Use caution when treating a female client who suspects she
is pregnant or has been trying to become
pregnant.

Keep essential oils away from the eyes.

Essential oils are highly flammable substances and should
be kept away from direct contact with flames, such
as
candles, fire, matches, cigarettes, and gas cookers.17

Safety Measures

If essential oil droplets accidentally get into the eye (or eyes) a cotton cloth or similar should be imbued
with
a fatty oil, such as olive or sesame, and carefully swiped over the closed lid.18 And / Or,
Immediately
flush the eyes with cool water.

If an essential oil causes dermal irritation, apply a small amount of vegetable oil or cream to the area
affected
and discontinue use of essential oil or product that has caused dermal irritation.

If a child appears to have drunk several spoonfuls of essential oil, contact the nearest poison control unit
(often listed in the front of a telephone directory). Keep the bottle for identification and encourage the child
to
drink whole or 2% milk. Do not try to induce vomiting.19

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